Staff Absence Form

Employee Name*

Email*

example@example.com

Todays Date*

Date

School/Building*

Day(s) Requested*

Type of Funeral Day(s)

Funeral Day(s)-mother, father, sister, brother, husband, wife, partner, children, Mother-in-law, Father-in-law, and Grandparents (up to 5 days)Funeral Day(s)-relative other than immediate family (1 day at the discretion of the Superintendent)Funeral Day(s)-friend (1 day that will be counted as a Personal Day)

Do Not Proceed Without Proper Supervisor APPROVAL*

By checking this box, I have confirmed verbal approval from my Supervisor

Reason for Personal Day (Reason must be given if used before or after holiday or if consecutive personal days are used).*

Reason for School Business Day (Proper documentation must be submitted with this form)*

Is Reimbursement Required?*

YesNo

I hereby request reimbursement for expenses incurred while attending (List Title of Convention, Conference, Workshop: Title of Event*

To be Held on:*

Date

At (Name of venue and address):*

My estimated expenses are:

	Amount
Registration Fee (if any)
Transportation
Car Allowance (Mile @ $0.47 per contract)
Tolls
Accommodations
Other Expenses (Parking, Etc)
Total

Date 1*

Date

Date 2

Date

Date 3

Date

Employee Signature*

Notes

File Upload